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Lateral internal sphincterotomy together with haemorrhoidectomy for treatment of haemorrhoids: a randomised
G Galizia1, E Lieto, P Castellano
1Department of Surgical Sciences, Second University of Naples School of Medicine, Italy.
Objective:
To investigate anorectal manometric findings in patients with haemorrhoids and to evaluate the clinical effects and physiological consequences of adding a lateral internal sphincterotomy (LIS) to haemorrhoidectomy.
Design:
Randomised prospective study.
Setting:
Teaching hospital, Naples.
Patients:
48 consecutive patients with prolapsed piles who had anorectal manometry; 10 healthy volunteers served as controls.
Interventions:
Resting and squeeze pressures, sphincter length and rectoanal inhibitory reflex were recorded. 6 patients were excluded because anal pressures were not raised, so 42 patients were randomised. 22 patients had haemorrhoidectomy plus LIS; and 20 had haemorrhoidectomy alone.
Main Outcome Measures:
Morbidity, continence, and anorectal manometry.
Results:
Sphincter anomalies were found in 87.5% (n = 42) of patients. Haemorrhoidectomy alone did not affect anal pressures, which returned to the normal ranges after sphincterotomy. Those who had LIS did better postoperatively than those who had did not. 4 patients who did not have a sphincterotomy developed anal strictures. No patient who had LIS developed incontinence of faeces.
Conclusions:
High anal pressures are common in patients with haemorrhoids suggesting that they may have a pathogenetic role; anorectal manometry is useful in the investigation of anal pressure patterns; and when indicated, lateral sphincterotomy avoids pain, urinary retention, and stenosis, and is safe.